中华骨质疏松和骨矿盐疾病杂志
中華骨質疏鬆和骨礦鹽疾病雜誌
중화골질소송화골광염질병잡지
CHINESE JOURNAL OF OSTEOPOROSIS AND BONE MINERAL RESEARCH
2015年
2期
132-137
,共6页
陈琳%游利%陈瑾瑜%潘凌%彭永德
陳琳%遊利%陳瑾瑜%潘凌%彭永德
진림%유리%진근유%반릉%팽영덕
绝经后骨质疏松症%雷洛昔芬%阿仑膦酸钠%骨密度%骨转换指标
絕經後骨質疏鬆癥%雷洛昔芬%阿崙膦痠鈉%骨密度%骨轉換指標
절경후골질소송증%뢰락석분%아륜련산납%골밀도%골전환지표
postmenopausal osteoporosis%raloxifene,alendronate%bone mineral density%bone turnover marker
目的:观察绝经后骨质疏松症患者应用阿仑膦酸钠治疗3~5年失效后改用雷洛昔芬的疗效。方法选取2005年10月至2013年10月在上海市第一人民医院骨质疏松门诊就诊的11538例患者中符合条件的绝经后骨质疏松症患者240例作为受试者并分为2组: A组(155例)仅用雷洛昔芬治疗; B组(85例)阿仑膦酸钠治疗3~5年失效后改为雷洛昔芬治疗。所有患者均同时加用活性维生素D及钙剂。采用回顾性分析,记录受试者一般资料,用药时间,治疗前后骨密度(BMD)、骨转换指标(BTM)、是否有新发骨折等临床资料。结果 A组治疗12个月后,腰椎、股骨颈、全髋骨密度较治疗前均明显升高( t=10.778, P<0.0001;t=3.587, P<0.0001; t=7.998, P<0.0001)。腰椎、股骨颈及全髋骨密度较治疗前分别上升3.3%、1.5%及1.4%(均P<0.05)。骨钙素(BGP)下降28.8%(t=6.392, P<0.0001),Ⅰ型胶原羧基端肽(β-CTX)下降44.5%(t=13.078, P<0.0001)。 B组应用雷洛昔芬治疗12个月后,腰椎、股骨颈、全髋骨密度较治疗前有上升趋势,但差异无统计学意义(t=1.093, P=0.277; t=1.896, P=0.061; t=1.045, P=0.299)。BGP及β-CTX治疗后年变化率较治疗前差异无统计学意义(t=1.608, P=0.112; t=1.621, P=0.109)。改用雷诺昔芬1年后,腰椎、股骨颈及全髋骨密度年变化率分别较换药前1年(即阿仑膦酸钠治疗最后1年)骨密度年变化率显著升高(t=3.729, P<0.0001; t=2.191, P=0.031; t=2.929, P<0.01)。 A组腰椎、股骨颈及全髋骨密度年变化率均显著高于B组( t=5.756, P<0.0001; t=0.713, P<0.0001; t=0.736, P<0.0001)。结论雷洛昔芬能显著增加初次用药的绝经后骨质疏松症患者骨密度,降低骨转换;应用阿仑膦酸钠治疗3~5年后失效者改用雷洛昔芬可显著减慢骨丢失率。
目的:觀察絕經後骨質疏鬆癥患者應用阿崙膦痠鈉治療3~5年失效後改用雷洛昔芬的療效。方法選取2005年10月至2013年10月在上海市第一人民醫院骨質疏鬆門診就診的11538例患者中符閤條件的絕經後骨質疏鬆癥患者240例作為受試者併分為2組: A組(155例)僅用雷洛昔芬治療; B組(85例)阿崙膦痠鈉治療3~5年失效後改為雷洛昔芬治療。所有患者均同時加用活性維生素D及鈣劑。採用迴顧性分析,記錄受試者一般資料,用藥時間,治療前後骨密度(BMD)、骨轉換指標(BTM)、是否有新髮骨摺等臨床資料。結果 A組治療12箇月後,腰椎、股骨頸、全髖骨密度較治療前均明顯升高( t=10.778, P<0.0001;t=3.587, P<0.0001; t=7.998, P<0.0001)。腰椎、股骨頸及全髖骨密度較治療前分彆上升3.3%、1.5%及1.4%(均P<0.05)。骨鈣素(BGP)下降28.8%(t=6.392, P<0.0001),Ⅰ型膠原羧基耑肽(β-CTX)下降44.5%(t=13.078, P<0.0001)。 B組應用雷洛昔芬治療12箇月後,腰椎、股骨頸、全髖骨密度較治療前有上升趨勢,但差異無統計學意義(t=1.093, P=0.277; t=1.896, P=0.061; t=1.045, P=0.299)。BGP及β-CTX治療後年變化率較治療前差異無統計學意義(t=1.608, P=0.112; t=1.621, P=0.109)。改用雷諾昔芬1年後,腰椎、股骨頸及全髖骨密度年變化率分彆較換藥前1年(即阿崙膦痠鈉治療最後1年)骨密度年變化率顯著升高(t=3.729, P<0.0001; t=2.191, P=0.031; t=2.929, P<0.01)。 A組腰椎、股骨頸及全髖骨密度年變化率均顯著高于B組( t=5.756, P<0.0001; t=0.713, P<0.0001; t=0.736, P<0.0001)。結論雷洛昔芬能顯著增加初次用藥的絕經後骨質疏鬆癥患者骨密度,降低骨轉換;應用阿崙膦痠鈉治療3~5年後失效者改用雷洛昔芬可顯著減慢骨丟失率。
목적:관찰절경후골질소송증환자응용아륜련산납치료3~5년실효후개용뢰락석분적료효。방법선취2005년10월지2013년10월재상해시제일인민의원골질소송문진취진적11538례환자중부합조건적절경후골질소송증환자240례작위수시자병분위2조: A조(155례)부용뢰락석분치료; B조(85례)아륜련산납치료3~5년실효후개위뢰락석분치료。소유환자균동시가용활성유생소D급개제。채용회고성분석,기록수시자일반자료,용약시간,치료전후골밀도(BMD)、골전환지표(BTM)、시부유신발골절등림상자료。결과 A조치료12개월후,요추、고골경、전관골밀도교치료전균명현승고( t=10.778, P<0.0001;t=3.587, P<0.0001; t=7.998, P<0.0001)。요추、고골경급전관골밀도교치료전분별상승3.3%、1.5%급1.4%(균P<0.05)。골개소(BGP)하강28.8%(t=6.392, P<0.0001),Ⅰ형효원최기단태(β-CTX)하강44.5%(t=13.078, P<0.0001)。 B조응용뢰락석분치료12개월후,요추、고골경、전관골밀도교치료전유상승추세,단차이무통계학의의(t=1.093, P=0.277; t=1.896, P=0.061; t=1.045, P=0.299)。BGP급β-CTX치료후년변화솔교치료전차이무통계학의의(t=1.608, P=0.112; t=1.621, P=0.109)。개용뢰낙석분1년후,요추、고골경급전관골밀도년변화솔분별교환약전1년(즉아륜련산납치료최후1년)골밀도년변화솔현저승고(t=3.729, P<0.0001; t=2.191, P=0.031; t=2.929, P<0.01)。 A조요추、고골경급전관골밀도년변화솔균현저고우B조( t=5.756, P<0.0001; t=0.713, P<0.0001; t=0.736, P<0.0001)。결론뢰락석분능현저증가초차용약적절경후골질소송증환자골밀도,강저골전환;응용아륜련산납치료3~5년후실효자개용뢰락석분가현저감만골주실솔。
Objective To observe the efficacy of sequential therapy of raloxifene in postmenopausal women with osteoporosisafter3to5yearstreatmentofalendronate.Methods 240eligiblecasesofpostmenopausalwomenwithoste-oporosis from 11 538 patients selected according to the inclusion criteria in Shanghai first people’s hospital between Octo-ber 2005 and October 2013 were collected.Subjects were divided into two groups (A and B).A group (155 cases):All patients newly initiated treatment with raloxifene.B group (85 cases): Patients with 3 to 5 years failure of alendronate treatment previously were switch to raloxifene.All patients received supplemental calcium and active vitamin D.A retro-spective statistical analysis was performed for basic clinical characteristics, duration of treatment, BTM, BMD and fracture data.Results BMD at lumbar spine, femoral neck and hip in the A group were significantly higher after raloxifene treat-ment for 12 months than that before treatment (t=10.778, P<0.000 1;t=3.587, P<0.000 1;t=7.998, P<0.000 1). The percent changes in BMD at the lumbar spine and femoral neck were 3.3% and 1.5% and 1.4 % ( P<0.05 ) . There was a significant difference in the percent decrease in BGP andβ-CTX at 12 months (t=6.392, P<0.000 1;t=13.078, P<0.000 1).B group switched to raloxifene after 3-5 years of alendronate treatment.BMD at lumbar spine, femoral neck and hip in the sequential therapy group were trend to be higher than that before treatment, but the difference was not statistically significant (t=1.093, P=0.277; t=1.896, P=0.061; t=1.045, P=0.299).No statistically significant difference of annual change rate of BGP andβ-CTX was found after raloxifene treatment than before.However, the percentage changes in the BMD at lumbar spine and femoral neck were significantly higher after raloxifene treatment for 12 months than that before treatment ( t=3.729, P<0.000 1;t=2.191, P=0.031; t=2.929, P<0.01) .The per-centage changes in BMD at lumbar spine and femoral neck were significantly higher in A group than in B group ( t =5.756, P<0.000 1; t=0.713, P<0.000 1; t =0.736, P<0.000 1).Conclusion Raloxifene significantly in-creased bone mineral density and reduce bone turnover in postmenopausal patients with osteoporosis.If alendronate treat-ment was secondary failure, we could switch to raloxifene treatment to reduce the bone loss.